MEDICARE: TONOKA HEALTH ENTERPRISES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A68432	CA

General Provider Information

NPI Number	:	1366937708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TONOKA HEALTH ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	24137 LONG VALLEY RD
Second Line	:
City	:	HIDDEN HILLS
State	:	CA
Zip	:	91302-1249
Country	:	US
Telephone Number	:	805-558-7059
Fax Number	:

Provider Business Practice Location Address
First Line	:	24137 LONG VALLEY RD
Second Line	:
City	:	HIDDEN HILLS
State	:	CA
Zip	:	91302-1249
Country	:	US
Telephone Number	:	805-558-7059
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID PRYOR
Credential	:	MD
Telephone Number	:	805-558-7059

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	06/27/2018

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